Cost and value of office-based facial plastic and reconstructive surgery procedures.

Introduction: This chapter will provide an overview of factors affecting the cost of office-based procedures in Facial Plastics and Reconstructive Surgery (FPRS), and will discuss the value of office-based interventions. Material and Methods: An in-depth literature review was conducted using multiple primary and secondary sources. Literature from multiple disciplines was included in the review, including otolaryngology, anesthesiology, surgery, public health, and economics. Discussion/Conclusions: A wide variety of procedures can be performed in an FPRS office. Large upfront costs to the office include laser, electrocautery and surgical equipment. These investments will yield an initial negative cost margin until sufficient case volume is achieved. It is often in the best interest of the patient to perform a procedure in-office and avoid the facility and anesthesia fees associated with a surgical center or hospital. Costs and reimbursements vary greatly across regions and facilities. Additionally, overall cost depends on payer mix, procedures performed, and productivity of the practice. The scarcity of literature on this topic as it applies specifically to FPRS indicates that further research is needed to elucidate the value of common facial plastics procedures in an office-based setting.

A Case of HPV+ Squamous Cell Carcinoma of the Perigeniculate Area and Middle Fossa.

Herein we present an unusual case of a primary HPV+ perigeniculate, extra-axial middle fossa skull base tumor and our management thereof. Laryngoscope, 133:3158-3160, 2023.

Duplication of the oral cavity and mandible: a rare congenital craniofacial anomaly.

A newborn girl was referred to the otolaryngology service after prenatal imaging showed a right mandibular mass. Physical examination revealed a 1-2 cm mass along the right mandible with the appearance of a vestigial oral cavity. Tissue resembling the vermillion and primitive tongue appeared innervated and moved in conjunction with oral movements. MRI and CT of the mandible after birth confirmed a partially ossified soft tissue mass of the right mandibular body, containing unerupted teeth. She was taken to the operating room at 6 months of age for mass excision and reconstruction. Postoperatively, she healed well and was feeding without difficulty. Craniofacial duplication, including duplication of stomatodeal structures or diprosopus, is a rare condition with a variety of phenotypes. In the case of suspected craniofacial duplication, associated syndromes should be ruled out and appropriate imaging employed to determine the extent of involvement of adjacent structures, which will ultimately guide surgical planning.

Characteristics and progression of hearing loss in children with turner's syndrome.

OBJECTIVES/HYPOTHESIS: Evaluate patterns of hearing impairment in children with Turner's syndrome (TS) and determine factors influencing severity and progression. STUDY DESIGN: Retrospective database review. METHODS: Demographic, audiological, and medical data for children with TS were extracted from the Audiological and Genetic Database to analyze patterns of hearing loss with comorbidities, demographics, and interventions. RESULTS: Two hundred seventy-two children with TS were identified; 213 had audiological data. Of these children, 72.3% (N = 154) had hearing loss in which 84.4% (N = 130) was bilateral. In individual ears, conductive hearing loss was most common (28.7%, n = 73), followed by mixed (22.0%, n = 93) and sensorineural (7.9%, n = 20). Otitis media (odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.2-6.5), eustachian tube dysfunction (OR = 9.5, 95% CI: 3.2-35.2), and aortic valve anomalies were also associated with higher rates of hearing loss (OR = 3.6, 95% CI: 1.3-11.5). Of ears with quantifiable severity, 16.3% (n = 40) had moderate or worse hearing loss. Aortic coarctation (36.3 vs. 21.3 dB, P < .001), seizures (40.6 vs. 21.3 dB, P = .006), facial anomalies (32.5 vs. 21.3 dB, P = .029), and hypertension (36.3 vs. 21.3 dB, P = .015) portended more severe loss. CONCLUSIONS: Children with TS have high rates of hearing loss. High rates of sensorineural loss were unexpected. Nonotologic comorbidities, including seizures, hypertension, and anomalies of the kidney and aorta were associated with greater prevalence, severity, and progression of loss. Children with TS, particularly with the above comorbidities, are at risk for poor hearing outcomes, and should be offered audiological intervention to efficiently direct patient care. LEVEL OF EVIDENCE: NA Laryngoscope, 130:1540-1546, 2020.

The pattern and progression of hearing loss in Marfan Syndrome: A study of children and young adults.

OBJECTIVE: (s): To describe the prevalence, type, severity, and progression of hearing loss (HL) in children and young adults with Marfan Syndrome (MFS), and to evaluate the influence of comorbidities on HL. STUDY DESIGN: Retrospective database analysis. RESULTS: Of 70 patients with MFS, 52.8% (N = 37) had HL. Within the HL group, 75.7% (N = 28) had bilateral HL, while 24.3% (N = 9) had unilateral HL. 21.4% (N = 15) had moderate or more severe HL. The overall prevalence of CHL was 40.5% (N = 15), SNHL 13.5% (N = 5), and mixed HL 37.8% (N = 14). The mean initial age of HL was 8.4 years (range 0.8-24.0). HL was more prevalent in patients with MFS who also experienced chronic otitis media (ES 1.00, 95% CI, 0.32-1.68) and skull anomalies (ES 0.75, 95% CI, 0.07-1.44) as well as for patients with hypertension (ES 2.17, 95% CI, -1.29-5.64). CONCLUSIONS: Children and young adults with Marfan syndrome have a high likelihood of hearing loss, with high rates of CHL, chronic otitis media, and Eustachian tube dysfunction. SNHL is also prevalent in this syndrome; hypertension increased the likelihood of SNHL. Early audiologic screening is needed to ascertain type of HL and to efficiently direct patient care in this population.